Adaptive servo ventilation (ASV) is an effective treatment option for patients with complex sleep apnea, according to a Philips-sponsored study published in the American Journal of Respiratory and Critical Care Medicine. The study, Comparison of Physiological Performance of Four Adaptive Servo Ventilation Devices in Patients with Complex Sleep Apnea, compared the performance of 4 different ASV devices with different algorithms, including Philips DreamStation BiPAP autoSV (pictured), and the ASV device that was originally associated with greater mortality during a prior SERVE-HF trial published in 2015. The recent study revealed that certain physiological performances were quite different across the devices.
In the prior SERVE-HF trial, it was suggested that ASV therapy was harmful to central sleep apnea patients with heart failure, with limited information suggesting that some of the patients in the trial may have received excessive minute ventilation that may have increased patient mortality. This new Philips-funded randomized controlled study suggests the mechanisms underlying the adverse effects of ASV may be secondary to excessive ventilation due to device-based effect rather than a class-effect.
“The pursuit for scientific understanding of various disease and treatment processes is an iterative process where we revisit successes and failures to deepen our understanding of disease processes,” says Sairam Parthasarathy, MD, a lead investigator on the study, professor of medicine and interim chief of Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at University of Arizona College of Medicine, in a release. “It’s imperative we keep this in mind and re-visit previous studies when technological advancements show promise for a certain type of therapy. Today, ASV isn’t used in certain clinical settings due to safety concerns associated with the therapy in patients with congestive heart failure and predominantly central sleep apnea. Now, through devices with smarter algorithms, providers can potentially ensure that patients are getting the right treatment and thereby improve treatment approaches in patients with complex or central sleep apnea.”
Teofilo Lee-Chiong, MD, chief medical liaison at Philips, says, “Philips provides healthcare professionals and patients with innovative treatment solutions and services. The safety of patients who use our devices is our top priority. We also wish to maximize the benefits that patients receive from using our technology. As a science company, we are obligated to understand why and how ASV in the SERVE-HF trial can be associated with increased risk of mortality in patients with central sleep apnea and severe heart failure. Future research is needed to confirm if excessive ventilation during wakefulness and sleep due to device-specific ASV algorithms can result in potentially life-threatening consequences, especially in patients with heart failure.”